华西医学

华西医学

肾移植后程序性活检监测下诊疗对移植疗效影响的系统评价与 Meta 分析

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目的对肾移植术后应用程序性活检(protocol biopsy,PB)指导临床诊疗提升患者预后的效果进行系统评价与 Meta 分析。方法检索 PubMed、Embase、Cochrane 图书馆、中国知网、万方、维普数据库从建库至 2018 年 5 月期间的相关文献,收集所有比较肾移植后根据 PB 结果及时进行相关干预与仅依据临床经验进行常规治疗患者之间疗效差异的随机对照试验(randomized controlled trial,RCT),评价纳入研究质量,提取有效数据,采用 RevMan 5.3 软件进行 Meta 分析。结果最终纳入 6 篇 RCT 共 698 例受试者。PB 组与常规治疗组之间的 1 年与 2 年受者生存率差异无统计学意义[1 年:相对危险度(relative risk,RR)=0.99,95% 置信区间(confidence interval,CI)(0.97,1.01),P=0.39;2 年:RR=1.00,95%CI(0.97,1.02),P=0.72],两组术后 1 年与 2 年移植肾存活率差异亦无统计学意义[1年:RR=1.01,95%CI(0.99,1.04),P=0.29;2 年:RR=1.02,95%CI(0.99,1.06),P=0.19];两组平均肾小球滤过率差异无统计学意义[均数差(mean difference,MD)=0.45 mL/(min·1.73 m2),95%CI(–3.77,4.67)mL/(min·1.73 m2),P=0.83],PB 组血清肌酐低于对照组[MD=–0.46 mg/dL,95%CI(–0.63,–0.29)mg/dL,P<0.000 01]。随访期间两组感染率差异无统计学意义[RR=1.23,95%CI(0.69,2.19),P=0.48]。结论现有证据不支持术后常规对移植肾行 PB。然而受限于较小的样本量与较短的随访时间,是否需要在特定人群中施行 PB 仍需要大样本、长期的 RCT 研究来明确。

ObjectiveTo conduct a Meta-analysis to determine the clinical effect of protocol biopsy (PB)-monitored therapy after renal transplantation.MethodsPubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Standards Database and VIP Database for Chinese Technical Periodicals were searched for trials comparing the efficacy of timely intervention under PB surveillance with the conventional treatment. The quality of included studies was assessed and Meta-analysis was conducted by RevMan 5.3 software.ResultsSix randomized controlled trials met our inclusion criteria, including 698 cases. No significant difference was found between the PB group and the control group in 1-year [relative risk (RR)=0.99, 95% confidence interval (CI) (0.97, 1.01), P=0.39] and 2-year recipient survival rate [RR=1.00, 95%CI (0.97, 1.02), P=0.72]. Graft survival rate after 1 year [RR=1.01, 95%CI (0.99, 1.04), P=0.29] and 2 years [RR=1.02, 95%CI (0.99, 1.06), P=0.19] were also statistically similar. No statistical difference was found in glomerular filtration rate between the two groups [mean difference (MD)=0.45 mL/(min·1.73 m2), 95%CI (–3.77, 4.67) mL/(min·1.73 m2), P=0.83]. Renal function of PB group, monitored by serum creatinine, was superior to the control group [MD=–0.46 mg/dL, 95%CI (–0.63, –0.29) mg/dL, P<0.000 01]. No statistical difference was found in infection between the two groups [RR=1.23, 95%CI (0.69, 2.19), P=0.48].ConclusionsOur study did not suggest PB for every kidney transplantation recipient. However, long-term randomized controlled trials with larger sample size would be necessary to determine whether PB was effective for specific populations.

关键词: 肾移植; 肾活检; 程序性活检; 疗效

Key words: Kidney transplantation; Renal biopsy; Protocol biopsy; Clinical effect

引用本文: 张若晨, 刘志洪, 唐良友, 邹子君, 姜亮, 王玉杰, 梁嘉宇, 唐涌泉, 卢一平. 肾移植后程序性活检监测下诊疗对移植疗效影响的系统评价与 Meta 分析. 华西医学, 2018, 33(7): 869-876. doi: 10.7507/1002-0179.201603300 复制

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